02/13/2008 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB241 | |
| SB107 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 241 | TELECONFERENCED | |
| + | SB 107 | TELECONFERENCED | |
| *+ | SB 239 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 13, 2008
1:33 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Thomas, Vice Chair
Senator John Cowdery - via teleconference
Senator Kim Elton
Senator Fred Dyson
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 241
"An Act relating to a report to the legislature on teacher
preparation, retention, and recruitment by the Board of Regents
of the University of Alaska."
MOVED CSSB 241(SED) OUT OF COMMITTEE
SENATE BILL NO. 107
"An Act relating to naturopaths and to naturopathic practice;
establishing a Naturopathic Advisory Committee and an Alaska
Naturopathic Formulary Council; amending the duties of the State
Medical Board and the Board of Pharmacy relating to naturopathic
practice; and providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 239
"An Act relating to the practice of dentistry and to dental
assistants."
SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: SB 241
SHORT TITLE: UNIV. REPORT: TEACHER TRAINING/RETENTION
SPONSOR(S): SENATOR(S) STEVENS BY REQUEST OF JT LEG EDUCATION
FUNDING TASK FORCE
01/18/08 (S) READ THE FIRST TIME - REFERRALS
01/18/08 (S) SED, HES
02/01/08 (S) SED AT 8:00 AM BUTROVICH 205
02/01/08 (S) Heard & Held
02/01/08 (S) MINUTE(SED)
02/06/08 (S) SED RPT CS 3DP 2NR NEW TITLE
02/06/08 (S) DP: STEVENS, WILKEN, DAVIS
02/06/08 (S) NR: OLSON, HUGGINS
02/06/08 (S) SED AT 8:00 AM BUTROVICH 205
02/06/08 (S) Moved CSSB 241(SED) Out of Committee
02/06/08 (S) MINUTE(SED)
02/13/08 (S) HES AT 1:30 PM BUTROVICH 205
BILL: SB 107
SHORT TITLE: NATUROPATHS
SPONSOR(S): SENATOR(S) DAVIS BY REQUEST
03/07/07 (S) READ THE FIRST TIME - REFERRALS
03/07/07 (S) L&C, HES, FIN
04/19/07 (S) L&C AT 1:30 PM BELTZ 211
04/19/07 (S) Heard & Held
04/19/07 (S) MINUTE(L&C)
01/15/08 (S) L&C AT 1:30 PM BELTZ 211
01/15/08 (S) -- MEETING CANCELED --
01/17/08 (S) L&C AT 1:30 PM BELTZ 211
01/17/08 (S) -- MEETING CANCELED --
01/22/08 (S) L&C AT 1:30 PM BELTZ 211
01/22/08 (S) Heard & Held
01/22/08 (S) MINUTE(L&C)
01/25/08 (S) L&C AT 3:00 PM BELTZ 211
01/25/08 (S) -- Rescheduled from 01/24/08 --
01/28/08 (S) L&C RPT CS 3DP 1NR NEW TITLE
01/28/08 (S) DP: ELLIS, DAVIS, HOFFMAN
01/28/08 (S) NR: BUNDE
02/13/08 (S) HES AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
PAT PITNEY, Vice President
Budget and Planning
University of Alaska Anchorage (UAA)
Anchorage, AK
POSITION STATEMENT: Presented overview of University of Alaska
(UA) educational programs.
CYNTHIA HENRY
Board of Regents
Chair of Academic Student Services Committee
University of Alaska
Fairbanks, AK
POSITION STATEMENT: Supported SB 241.
TOM OBERMEYER,
Staff to Senator Davis
Alaska State Capitol
Juneau, AK
POSITION STATEMENT: Presented an overview of SB 107.
JENNIFER STRICKLER, Licensing Chief
Division of Corporations
Business and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, AK
POSITION STATEMENT: Answered questions on SB 107.
DR. MARY MINER, Naturopathic Doctor and Secretary
Alaska Association of Naturopathic Physicians
Palmer, AK
POSITION STATEMENT: Supported SB 107.
DR. JOHN RASTER
Alaska State Medical Association
Juneau, AK
POSITION STATEMENT: Opposed SB 107.
DR. EMILY KANE, Naturopathic Doctor
Juneau, AK
POSITION STATEMENT: Supported SB 107.
DR. ALEX MALTER, Internist
Juneau, AK
POSITION STATEMENT: Opposed SB 107.
ACTION NARRATIVE
CHAIR BETTYE DAVIS called the Senate Health, Education and
Social Services Standing Committee meeting to order at 1:33:31
PM. Present at the call to order Senators Thomas, Elton, and
Davis, and Senator Cowdery was on teleconference.
SB 241-UNIV. REPORT: TEACHER TRAINING/RETENTION
CHAIR DAVIS announced the consideration of SB 241. [The
committee was considering CSSB 241(SED).]
1:34:39 PM
SENATOR STEVENS said SB 241 represents a recommendation from the
Joint Legislative Education Funding Task Force (JLEFTF). This
bill requests that the University of Alaska Board Of Regents
come into closer dialogue with the legislature. This bill
specifically asks the Board of Regents to sit down on an annual
basis and talk with the legislature whether it's with the health
and social services committee or the special education committee
and talk about what's going on with teacher education in the
state. There are enormous needs for teachers in Alaska and
there's a desire to produce as many teachers as possible
locally. The bill requires the regents to present a report to
th
the proper committee on the 30 legislative day of each session
on an annual basis until 2013. After that it would be required
every other year.
He said the question arose about whether it was proper or even
necessary to put it into statute, but there was a concern that
it might be forgotten, especially with different legislators.
1:37:07 PM
SENATOR DYSON joined the meeting.
SENATOR ELTON said that one of the things discussed is the
quality of entering students at the University of Alaska. He
asked Senator Stevens how it came to be narrowed down to teacher
preparation. He said it would be important to also have a report
of the types of high school students that were entering and what
kind of challenges are faced by those students.
SENATOR STEVENS said that was beyond the purview of this task
force. They were specifically focusing on teacher preparation.
He agreed that Senator Elton's concern should be addressed. He
said that wasn't something that needs to be known on an annual
basis while teacher training does need to be addressed annually.
1:39:08 PM
SENATOR STEVENS said another request of the task force was to
establish a standing committee on education that could be a
forum for university oversight.
SENATOR COWDERY asked how the bill will be different from what
the university already has. He also asked if other incentive
methods for retaining teachers like bonuses had been discussed.
SENATOR STEVENS said this was specifically a recommendation by
Senator Wilken who thought the university had plenty of programs
to help train teachers but legislators were never brought into
the picture in a systematic way to know what was going on.
Therefore, this bill only deals with the university's workforce
development in education and the hiring and training of
teachers. It does not go beyond that. The whole purpose of this
bill is to bring the legislature up to date on an annual basis
on what the university is doing in its responsibility to train
teachers in Alaska.
1:42:31 PM
PAT PITNEY, Vice President, Budget and Planning, University of
Alaska Anchorage (UAA), Anchorage, AK presented an overview of
programs. There are Schools of Education in Anchorage, Juneau
and Fairbanks. Each school provides programs for their region
for on-campus and off-campus needs ranging from baccalaureate
programs to master's programs. There was a large transition in
teacher education in the early 2000s that shifted away from
baccalaureate degree teacher certification to master's degree
certification. It has since eased back into additional
baccalaureate programs. This has presented a significant change
in teacher preparation.
She said the number of graduates produced in Alaska isn't
sufficient to meet all the openings, especially in special
education, math and science, primarily in the rural communities.
In addition to teacher preparation programs there are other
activities that the university participates in including the
Future Teachers of Alaska which gets younger students interested
in teaching as a career; and the Native Educators Student
Association at UAS that encourages more Native students into the
teaching profession. Other successful programs are the Alaska
Teacher Placement Program and the Teacher Mentoring Program in
partnership with the Department of Education, which reaches 400
new teachers each year, placing master teachers with new
teachers. It has proven very effective in keeping teachers in
the profession by providing early support and mentoring.
MS. PITNEY said there has been significant research on Alaska
teacher supply and demand through the Institute of Economic
Research (ISER). It has answered questions like how many
teachers are needed in the state and in what areas, and how the
university and other teacher training is filling those needs.
Alaska Teacher Placement is particularly instrumental in that
area.
She said there is a four-page summary document in the bill
packet describing these programs. It is important to have
teachers working in Alaska trained here, and the university is
comfortable with the legislature's proposal to have this report
be in statute.
1:48:16 PM
CYNTHIA HENRY, Member, Board of Regents, University of Alaska,
and Chair of Academic Student Services Committee, Fairbanks, AK,
said she appreciated Senator Steven's summary of the bill. She
said the Board of Regents would agree that there's no mission of
the state university more important than training teachers for
local schools, and closing the gap is a laudable goal. Having
teachers who graduated from the University of Alaska talking to
their students about the university encourages those same
students to pursue their postsecondary education at Alaska's
universities. She said the Board of Regents has not considered
retention of teachers in much depth. She agreed that the mentor
program has a huge influence in this area. She supports the
regents' assignment to meet with legislators on this topic once
a year with the goal of a readable report.
1:53:43 PM
SENATOR THOMAS said there are many areas regarding the
university that interest legislators, but this is one of the
more important ones because it deals with K through 12.
1:57:28 PM
SENATOR STEVENS said it had been helpful to hear about the wide
variety of things the university is involved in. The university
and the legislature are in agreement regarding the need for this
forum. It's not just about what the regents are doing. It will
inform the legislature how it can best help as well.
1:58:57 PM
SENATOR THOMAS moved to report committee substitute for SB 241
from committee with individual recommendations and accompanying
fiscal note(s). Hearing no objections, CSSB 241(SED) moved out
of committee.
SB 107-NATUROPATHS
2:00:44 PM
CHAIR DAVIS announced consideration of SB 107. [The committee
was working from CSSB 107(L&C), 25-LS0702\M.]
TOM OBERMEYER, Staff to Senator Davis, sponsor of SB 107, said
changes from the original bill for purposes of expanding the
scope of practice and regulating naturopathic medicine in Alaska
were created in the Senator Labor and Commerce Committee on
January 2008. A task force assigned to study the matter in the
rd
23 legislature failed to produce a report.
This bill establishes required licensing fees and an Alaska
Naturopathic Council comprised of five members: two naturopaths,
two public members, and one pharmacist appointed by the Board of
Pharmacy. This bill authorizes naturopaths to perform the
formerly prohibited acts of minor surgery using antiseptics and
local anesthetics; and to prescribe drugs by obtaining a
prescription endorsement from the Department of Commerce,
Community & Economic Development's Division of Corporations,
Business and Professional Licensing, after first obtaining a DEA
authorization.
This bill also authorizes naturopaths to order laboratory and
imaging tests consistent with naturopathic medical education and
training. It prohibits major surgery, and spinal and general
anesthetics.
Oversight was changed from more rigorous state regulations
involving Medical Doctors (MD) and the State Medical Board to
largely self-regulation by two naturopaths, one public member
and one pharmacist. This change was reportedly due in part to
unwillingness by medical doctors and the State Medical Board to
oversee the practice for liability reasons, as well as
differences in training and ethical responsibilities. It may
also reflect the added expense of multiple committees for such a
small membership, one of the reasons a formal board was not
created and funded initially. The bill does, however, leave open
the public member position for an MD willing to volunteer on the
Alaska Naturopathic Council.
The advisory committee and formulary council were removed. The
advisory committee would have selected the formulary council and
reviewed allegations of misconduct. The formulary council would
have included a medical doctor or osteopath and pharmacist
appointed by their respective boards to approve designated
prescription drugs and to authorize prescription endorsements to
qualified naturopaths.
2:02:15 PM
MR. OBERMEYER explained that the Division of Corporations,
Business and Professional Licensing, has had full licensing
responsibility for licensing and regulating naturopaths in
Alaska since 1994. In 2002 Alaska had an estimated 44 licensed
naturopaths, several with addresses in other states. About a
dozen have very active practices and view the expanded scope of
this bill as recognizing an important natural extension of their
training and everyday practice.
The department only licenses naturopaths who have provided
satisfactory proof of graduation from one of four accredited on-
campus school, of naturopathy in the United States(US). They
must also pass the Naturopathic Physicians Licensing
Examination. Naturopathic licensing and practice procedures are
found in 15 states. Nine allow various levels of prescribing
privileges and different levels of independence and supervision
by state medical and pharmacy boards, licensing agencies and
MDs. A number of states prohibit licensing naturopaths,
including Massachusetts and South Carolina. Nevertheless, this
bill recognizes the growing interest in naturopathy nationwide.
This bill attempts to expand naturopathic scope of practice
while providing enough oversight to protect the public.
SENATOR COWDERY said he thought that generally these councils
were appointed by the governor. He asked why this bill has the
councils appointed by the commission.
2:06:14 PM
JENNIFER STRICKLER, Licensing Chief, Division of Corporations,
Business and Professional Licensing, Department of Commerce,
Community & Economic Development (DCCED), Juneau, AK, said that
she consulted with the Department of Law (DOL) about appointing
the members. DOL said that if it's an advisory council to the
department and the department is the regulatory agency there is
no constitutional issue. But if this council sets regulations
it must be appointed by the governor.
MS. STRICKLER further commented that the bill creates a five-
member Alaska Naturopathic Council and expands the scope of
practice to allow prescriptive authority and the performance of
minor surgery. Her division is responsible for regulation of
programs established without a board; naturopathy is one of
those programs.
She said her mission is to protect the public by insuring that
only safe, competent and qualified practitioners can offer
services to Alaskan consumers. Her division is not staffed by
industry members, but she has access to practitioners of other
health care industries whom she turns to for opinions and
guidance. For instance, she said, since licensure was created in
1994, only 44 naturopaths are licensed and 37 have Alaskan
addresses. No complaints were filed in FY05; only one complaint
of unlicensed activity was filed in FY06; and no complaints were
filed in FY07. Only the fees have changed under the self-
sufficiency laws.
MS. STRICKLER said the creation of this council, whether
advisory or regulatory, is an expensive proposition. The
licensing of naturopaths is under the Centralized Licensing Act
in AS 08.01.065 that requires programs to be self-sufficient
through licensing fees. Any expenses arising from a council need
to be paid for through an increase in naturopathic licensing
fees. Currently, this program is staffed by one position that
also provides support to nine other programs without licensing
boards. The creation of a council will require the need of a
staff person to keep the official records as required under the
Alaska Procedures Act.
If naturopaths are allowed to expand their scope of practice,
she said there will be a need to establish a regulatory
oversight entity. The bill currently establishes the Alaska
Naturopathic Council within the DCCED under guidance from the
governor's office. However, she proposed that this council be
established through boards and commissions in the governor's
office and not the department. A process already exists to make
such appointments and recreating the process within the
department would be cumbersome.
MS. STRICKLER had other concerns. The department maintains that
it is the industry's responsibility to convince the legislature
of the value in expanding the scope of practice. She said that
in 2004, the State Medical Board wrote a letter unanimously
opposing the expanded practice presented in the bill. Their
reasoning was that naturopathic theory and practice are not
based on the body of basic knowledge related to health, diseases
and health care that has been widely accepted by the scientific
community. Moreover, irrespective of its theory, the scope and
quality of naturopathic education does not prepare the
practitioner to make an adequate diagnosis and provide
appropriate treatment.
More alarming is the Medical Board's statement that "the
education and training attained by those who practice
naturopathy does not prepare them adequately in modern
pharmacology nor are they sufficiently trained and skilled to
perform surgical procedures." It said naturopaths receive four
years of education which consists of two years of didactic
training and two years of clinical training. Allopaths and
osteopaths typically get 8-12 years of education and training.
Section 5 on page 4 requires 60 hours of education from an
approved program to gain prescriptive authority. Physician
assistants (PA) are required to have formal training in addition
to clinical rotation training for at least a year, similar to
medical doctors, before being allowed to prescribe or perform
minimally invasive procedures. Advanced nurse practitioners
(ANP) are required to have formal training and work under a
preceptor to perform minimally invasive procedures. They are
required to obtain additional pharmacology hours.
Both PAs and ANPs could originally practice only under an
approved collaborative plan with a medical doctor. Veterinarians
possess a minimum of eight years of education; their junior
surgery training begins in the seventh year of schooling and
minor surgery is performed independently once they graduate
after eight or more years of schooling. Some choose never to do
surgery while others specialize in it. Pharmacology training
spans approximately six years of education.
Information from the Commonwealth of Massachusetts Special
Commission on Complimentary and Alternative Medical
Practitioners Minority Report questions the quality of
naturopath education, experience, and efficacy of treatments,
accuracy of diagnosis, and the rational basis of their beliefs.
The majority report suggested that regulation exclude certain
practices such as surgery and prescribing controlled substances.
It suggested creating regulations to establish standards for
required collaboration between naturopathic doctors and
conventional medical doctors.
The writings by Kimble C. Atwood, MD, state "for an occupation
with little semblance of objective, scientific and ethical
basis, licensure legitimizes an otherwise illegitimate and
dangerous activity." Arnold S. Wilman, M.D., who studied the
text book of normal medicine used in schools of naturopathic
medicine, stated that the text book explains that "naturopathy
objects to the use of pharmaceutical agents and depends instead
on the use of herbal or natural remedies of unproven value." She
said information like this has caused Alaskan regulators to
question whether allowing licensed naturopaths to expand their
scope of practice to perform minor surgery and be granted
prescriptive authority is really in the best interest of Alaskan
consumers.
If the legislature wants to expand the scope of practice, she
suggested they be allowed to perform under an approved
collaborative relationship plan with a conventional medical
doctor.
2:14:31 PM
CHAIR DAVIS asked if Ms. Strickler would support this bill if
the bill incorporated her recommendation.
2:16:06 PM
MS. STRICKLER answered she has a neutral position other than
urging the committee to adopt her suggestion. She would
implement what the legislature enacts.
SENATOR DYSON asked if she knew of reports of harm to patients
in the last four or five years.
MS. STRICKLER said her investigative unit had no record of
complaints or harm.
SENATOR DYSON asked if she would have known of legal or civil
actions taken.
MS. STRICKLER answered yes.
SENATOR DYSON asked if this bill has limits for their
prescriptive authority.
CHAIR DAVIS answered yes.
MR. OBERMEYER said his understanding is that naturopaths want to
prescribe all legend drugs, not narcotics. It was intended that
the Board of Pharmacy would deal with this issue.
2:19:25 PM
SENATOR THOMAS said he was concerned that someone who referenced
Dr. Atwood called naturopaths witch doctors. When someone takes
that approach, he said he is suspicious of their motivations. He
wanted to know what the department's real feelings were on the
subject and felt that he needed more direction.
SENATOR DYSON asked if they had heard from the State Medical
Board on this issue.
CHAIR DAVIS said not within this session. Three or four years
ago an advisory group was established, but nothing came of it.
The bill has been introduced several times since then.
SENATOR COWDERY commented that Senator Seekins had a task force
on the subject. He asked if there was a definition of "minor
surgery."
CHAIR DAVIS replied that the bill didn't have a definition, but
she would have a professional address that issue.
2:23:12 PM
SENATOR ELTON asked if any studies or reports have covered the
issue of medical mistakes by naturopaths compared to medical
mistakes by other health practitioners.
MS. STRICKLER said she wasn't familiar with any such reports at
this time, but she would look into that.
SENATOR COWDERY asked if naturopaths are required to have
malpractice insurance.
2:25:18 PM
MARY MINER, Naturopathic Doctor, Secretary, Alaska Association
of Naturopathic Physicians, Palmer, AK, referred the committee
to the Legislative Research Report 05.074. that was requested by
Representative Kott on complaints against naturopathic doctors
and disciplinary actions against licensed physicians in selected
states 1997-8. There weren't enough complaints against
naturopaths to make an accurate comparison, but it indicated in
Arizona, Washington and Oregon, naturopaths had half the
disciplinary actions per capita as medical doctors.
She said this isn't novel legislation; naturopaths in other
states have had prescriptive authority since approximately 1985.
Their record for safety is amazingly good.
Regarding Senator Dyson's question about prescriptive authority,
the bill does not provide for unlimited prescriptive authority.
The reason for the council is to look at the formularies of
other states so it can recommend certain criteria. She said the
authority extends by and large to legend drugs, which are non-
controlled substances that have a very low potential for abuse
or dependency.
2:30:21 PM
She explained that most of the schools where naturopaths are
trained have had the ability to write prescriptions since the
mid-80s. She also pointed out that Dr. Atwood's complaints of
several years ago were presented in Massachusetts, a state with
no licensed naturopaths, and that there is a big difference
between so-called schools that are certificate mills and schools
that provide four years of rigorous training.
DR. MINER said she sent Ms. Strickler a head to head comparison
of University of Washington Medical School's WAMI (Washington-
Alaska-Montana-Idaho Medical School) Program and the Bastyr
University's school including the requirements to get into the
program. It's easy to see that there are many more similarities
than there are differences. All their programs are certified
through the US Department of Education which accredits medical
schools as well as naturopathic schools. They have been vetted
and there is a standard.
She said she has been practicing in Alaska since 1990. The
present state of medicine is far more integrative than it was 20
years ago and that trend will continue into the future. It's
important for people who are taking responsibility for their own
health to have the guidance of someone who has a foot in both
worlds. As the doctor shortage becomes worse, it's in the best
interest of the public to have well-trained qualified people who
can give appropriate treatments for problems like diabetes,
infections and heart diseases.
DR. MINER said "There's no data that supports that where this
has been done in other states, the public health has been
harmed."
2:35:00 PM
CHAIR DAVIS said this is not the bill's first referral; it came
from the Labor and Commerce Committee where no concerns were
expressed.
DR. JOHN RASTER, Alaska State Medical Association, Juneau, AK,
said that as a private practice physician he appreciates the
naturopathic community operating within its realm. They provide
good service to many patients, but he objects to the expanded
scope of practice in SB 107. He said the board's concerns have
been voiced in the past. The two main concerns are access to
care and patient safety, and how that relates to the training of
naturopaths versus physicians. He said it's true there is a
shortage of medical doctors, but neither Medicaid nor Medicare
reimburses naturopathic care so he didn't think expanding the
scope of practice would significantly augment access to care.
In terms of patient safety and training, the two issues are
medical prescription ability for non-controlled substances and
surgery. To get a physician's license in Alaska, you have to
have graduated from four years of medical school; naturopaths
also need four years. However, a physician has to practice for
two years under someone in residency training in order to write
a prescription. He said that non-controlled substances can sound
innocuous, but they can be problematic because they include
drugs like insulin, which if given in too high a dose can kill
someone. Non-controlled substances include chemo-therapy for the
treatment of cancer. Part of learning how to prescribe medicine
is learning pharmacology, a broad education including seeing
patients, and being under tutelage.
DR. RASTER said in terms of overall philosophy, medical doctors
are pushing more and more towards evidence-based medicine, and
naturopathy has generally not been as interested in evidence-
based care. All the medications naturopaths are asking to
prescribe have to pass muster with evidence-based care because
the drugs have to get through the FDA. In order to get through
the FDA, there must be evidence that a substance does what it
says it's going to do.
Medical school trains doctors to do surgery under the eyes of a
trained surgeon, but still a doctor cannot get licensed in
Alaska even to do minor surgery without two years of residency
training. This bill allows surgery under local anesthesia with
significant complications in an office. He noted that physicians
are required by state law to carry malpractice insurance.
2:41:53 PM
SENATOR ELTON asked if Dr. Raster saw any mitigating amendments
that could be made to the existing bill that would help the
board get beyond some of the concerns raised; for example,
having an MD on the board or having a regular board that is
appointed by the governor with all the authority of law under
the Department of Commerce, or having a naturopath operate under
the endorsement of an M.D.
DR. RASTER answered that he knows a little about what is done in
other states where naturopaths are licensed, but he wasn't aware
of great collaboration existing between the two professions. His
main concerns are that the formulary would be decided by a board
that would consist of naturopaths. Essentially that could be
expanded to include all drugs. Having one physician on the board
wouldn't necessarily help. About a half dozen states allow some
restricted prescription ability by naturopaths, but only Arizona
allows uncontrolled substances. He didn't know their experience.
He suggested that a group could be formed to look at that issue
rather than relying on his testimony.
2:44:06 PM
SENATOR DYSON said he's torn on this issue. The two naturopaths
who practice in his community have good reputations and a wide
following. A number of folks have said they've been helped by
naturopaths and he's impressed with that. He also knows medical
doctors who have said it's all quackery. At best they do no
harm, but people are duped into thinking they're getting good
treatment for their particular pathology when actually they're
kept from getting to someone who could really help. He also said
that a particular demagogue admitted that he had had to eat
crow. The New England Journal of Medicine had published an
article about the efficacy of a particular compound that
naturopaths had been talking about for years and he was forced
to admit that, "Darn it they were right."
SENATOR DYSON said he understands that there are so many
prescriptive medicines available that there's significant danger
of drug interactions. Many carry strong warnings about mixing
prescription drugs without the primary physician's knowledge.
That concern rings true for him. He noted that previous
testimony indicates that AMA members in Alaska have been
reluctant to sit on this board or to exercise any oversight for
naturopaths.
DR. RASTER replied there was a task force sometime before he
became an Alaska AMA board member. He doesn't know what went on,
but perhaps Dr. Malter could speak to that.
2:48:06 PM
SENATOR THOMAS said he too is concerned, but it's also difficult
to sort out the fact that tens of thousands of people die each
year in hospitals under the care and treatment of medical
doctors. He's become accustomed to listening to people in
competing situations downgrade the ability, efficacy or
reasonableness of the other viewpoint and he tries to sort that
out as well.
SENATOR THOMAS said he'd like to see people who are a bit more
participatory figure out how to do this. Differences in medical
training obviously exist but he hopes the state is able to sort
out the differences between the degrees that are granted from
various schools. It would be helpful if there were more
cooperation to promote what would be good for Alaska. That
doesn't necessarily mean a broader approach to medical
treatment. It could just mean more availability. This may be an
opportunity for people that look at medicine in a different
fashion in the overall efforts to bring effective care into
rural areas. The question is how to get doctors to work with
naturopaths. He added that there's a shortage of doctors and
trained professionals in urban areas but the need is dire in
rural areas.
DR. RASTER replied he isn't sure SB 107 is the vehicle to get
medical care to rural areas. With respect to collaboration, he
refers patients to naturopaths when he has hit brick walls. In
terms of cooperation at the state level, there's little data
because this doesn't occur in most other states. "We're starting
from ground zero." The alternative would be for the naturopathic
community to make its training more similar to medical training
in order to write prescriptions, perform medical procedures, and
have evidence-based studies, mini-residencies and/or surgical
training residencies. Historically doctors of osteopathy were
separate from medical doctors dealing with spine alignment and
non-traditional therapy. They have become more scientific and
evidence-based and as a consequence, most people don't notice
much difference. If that model were to happen from the bottom up
that would seem reasonable. There is certainly a way to move
forward if common ground could be found. Bu it's a hard task to
create a sort of mini-residency here for 30 naturopaths to
become more medicalized.
2:52:58 PM
SENATOR ELTON noted that his testimony didn't address a
naturopath's ability to order and perform diagnostic and imaging
tests consistent with their training. He asked if that's an
issue with him or the AMA.
DR. RASTER replied it's not as big an issue in terms of doing
potential harm. "Delay in diagnosis certainly is a problem, but
not as identifiable as cutting a nerve or killing someone with
insulin."
SENATOR ELTON recalling previous debates on prescriptive
authority, asked what practitioners, other than optometrists,
have prescriptive authority now but didn't in the recent past.
DR. RASTER replied that only optometrists come to mind.
SENATOR ELTON asked if midwives have prescriptive authority.
DR. RASTER replied he doesn't have that information, but he
doesn't believe so.
CHAIR DAVIS informed members that nurse practitioners have
prescriptive authority.
DR. RASTER agreed.
SENATOR ELTON said other testifiers may want to comment on
whether or not the expansion of prescriptive authority created
medical issues or caused harm to the public.
DR. RASTER suggested there's a lack of data.
2:55:44 PM
CHAIR DAVIS advised that some 12 or 13 states already do exactly
what this bill proposes. Information regarding how the boards
are set up should be easy to come by, and she'll make sure the
committee has that information before the next hearing.
DR. EMILY KANE, Naturopathic Doctor, Juneau, AK, said she will
summarize three areas: education of naturopathic doctors, access
to healthcare in general and public safety. She noted that some
committee members asked for information comparing disciplinary
reports between allopaths and naturopathic doctors in different
states as well as comparative training. She distributed a
document with those facts.
DR. KANE said SB 107 establishes a five-member council
consisting of two naturopaths, one pharmacist, and two public
members. One of the public members may be a medical doctor. The
intent is to pave the way to better use naturopathic doctors as
primary healthcare providers in Alaska. "We are designated
primary healthcare providers, and state-based insurance pays for
us." Although Medicare and Medicaid don't reimburse for
naturopathic services, that is a federal issue that is currently
being debated. She estimated that topic will come up on a
national level in the next four to eight years.
DR. KANE said that her education is fairly typical of licensed
naturopaths in Alaska. To become licensed in this state it's
necessary to have graduated from one of the four accredited
schools of naturopathic medicine in the US, and an undergraduate
degree is a prerequisite for entry. Her undergraduate studies
were at Harvard University where she graduated with honors. She
pursued a different career for about ten years before entering
medical school at Bastyr University. She was in medical school
for six years followed by one year of residency training or
preceptorship. Part of her residency training included three
months in two major teaching hospitals in China. One reason she
went to China is because it isn't easy for naturopathic doctors
to find residencies in the US. When she graduated there were
about 1,000 licensed naturopaths in the country and now there
are about 5,000. During her three-month residency training she
had almost 600 patient contacts and she saw lots of pathology.
Thereafter, she passed national licensing examinations including
14 clinical and 6 basic science exams. The basic sciences exams
are completely comparable to medical doctor basic science
examinations. The clinical exams are somewhat different in that
there is greater emphasis on dietary and herbal therapeutic
training. She had four or five quarters of study in pharmacology
and in order to maintain her license in Alaska, she needs 23
hours of continuing education each year. Seven of those hours
must be pharmacology continuing credits even though her ability
to use pharmacologic agents is limited. Most of the legend
drugs, antibiotics and anti-hypertensives, she's interested in
being able to offer her patients are not legally available for
her to prescribe now, although she maintains current training in
those substances.
DR. KANE said that since 1996 she has enjoyed a good
relationship with the local hospital and has been on its roster
as an allied healthcare provider. Part of maintaining that
liaison requires that she carry malpractice insurance so she has
standard $3 million/$1 million coverage. She surmised that most
of her colleagues have similar malpractice coverage. She has
never used her insurance. "There is a very, very low incidence
of malpractice action against naturopaths." That's one reason
her insurance is still affordable.
DR. KANE said that her liaison with the hospital also requires
re-credentialing every two years. She has a sponsoring medical
doctor and she must prove continuing education and up-to-date
malpractice insurance. The hospital reviews the ways she's used
the facility. She has diagnostic and admitting privileges, but
once a patient is admitted she can't provide therapies. She
regularly uses the diagnostic facilities at Bartlett because she
doesn't have X-ray or ultrasound equipment in her office.
3:03:18 PM
DR. KANE noted that Dr. Raster and Dr. Malter are part of her
referral base and both have extended good care to her patients.
Her interactions with the MD community have been courteous and
helpful and her patients have been helped. "What doesn't help my
patients is when I could provide service that they need right
now that I'm capable of providing and for various reasons they
don't follow up on my recommendations, and sometimes they can
come to harm because of that." She related two stories to make
the point that some patients prefer using alternative
healthcare. In the second circumstance her patient just didn't
get around to going to see the regular medical doctor.
3:07:28 PM
DR. KANE said that SB 107 will give Alaskans instant access to
several dozen more fully-trained wellness professionals that are
capable of medication management in minor in-office procedures.
Her training in minor surgery included removing moles, punch
biopsies, removing splinters, and suturing lacerations. She
agreed with previous testimony that not all naturopaths will
want this extension, but her style is as a primary care doctor,
and she'd like to serve her patients in that capacity. SB 107
will help to fill that need.
SENATOR DYSON said he's impressed with her attitude.
SENATOR THOMAS asked if her course of study was required for her
degree or was some of it simply what she chose to do.
DR. KANE replied, "I don't think you need to go to an Ivy League
college to become a naturopath, but you do need a four-year
undergraduate degree." She elected to go to China to get more
patient contact. A certain number of patient contacts are
requisite in order to complete the clinical portion of the
training. Alaska requires naturopaths to pass national licensing
exams, and every two years their continuing education
certification must be updated. Alaska is the only state in the
block of western states including California, Oregon,
Washington, Idaho, Arizona, and Colorado that doesn't allow
naturopathic doctors to prescribe a limited roster of legend
drugs. That does not include narcotics or chemotherapeutics.
SENATOR THOMAS asked if the required undergraduate degree has to
be in a relevant field.
DR. KANE said it does not and her undergraduate degree wasn't
science based. She went to a community college for two years to
get basic sciences before she could enter the graduate program.
3:11:47 PM
DR. ALEX MALTER, Internist, Juneau, AK, said that several years
ago he participated in Senator Seekins' task force as a
representative of the medical community. It was formed to find a
solution to the same difficult questions that have been raised
here. That legislature didn't think a solution could be
fashioned during the 120-day legislative session.
DR. MALTER said he was disappointed that there wasn't a final
report, but his observation was that Senator Seekins and others
ultimately weren't comfortable crafting the solution that they
had originally anticipated. "That was my impression of why we
didn't get a report out of that task force."
DR. MALTER explained that the task force looked at some of the
curriculum that was to be covered in four-year naturopathic
schools. The information came from a text of naturopathic
physicians, probably from the preeminent Bastyr University. It
lists the scope of practice and types of therapeutics a
naturopathic physician may choose including: acupuncture,
botanical medicine, clinical nutrition, electro-hydrotherapy,
homeopathy, light and air therapy, massage therapy, naturopathic
manipulative techniques, psychologies, manipulations, surgery,
and use of appropriate pharmacological agents.
DR. MALTER said his concern has been that for an internist, the
first two years are in the classroom, the last two years in
medical school and the three years of residency training are
essentially dedicated to putting together diagnostic and
therapeutic techniques and learning to prescribe safely and
appropriately. That's five years of on-the-job training before
going out to practice. In Alaska it takes at least two years
after medical school to get licensed. His concern is that when
he looks at the list of therapies that naturopaths are expected
to master, he's not sure there's time in the four years to learn
how to safely prescribe medicines. Doing 60 hours of
pharmacology to get certified by the council as called for in
the bill, might sound equivalent to what happens in the first
year of medical school, "but it's not the pharmacy classes or
Continuing Medical Education(CME) credits that makes you a
prescriber." Safe prescribing comes from five years of on on-
the-job training under the direct observation of practicing
professors.
3:15:56 PM
DR. MALTER agreed with Dr. Kane that in many ways and on many
levels there's a good relationship between western allopathic
doctors and some of the naturopaths in the state. But it's not
realistic to think that the required classroom time plus 60 more
hours is sufficient to really learn to safely prescribe. He's
wary that the state wants to sign off on a council of five,
decreeing what a group of people who might have minimal training
could prescribe. Four years ago when he looked into the issue of
residency for naturopaths he understood that the extra year of
training after naturopathic school wasn't required.
DR. MALTER suggested that the task force idea was a good idea
and a compromise might be to put together another one. As a
member of the board of trustees for the state medical
association, he assured the committee that the association would
be happy to participate as it did previously. He disclosed that
he also works for the Department of Health and Social Services
(DHSS) as the Medicaid medical director. He clarified that DHSS
does not have a position on the bill. His testimony has been
personal.
CHAIR DAVIS announced she would hold SB 107 in committee. She
wasn't sure a task force was needed but she wants to formulate a
plan to move forward if possible.
There being no further business to come before the committee,
Chair Davis adjourned the meeting at 3:19:39 PM.
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